Knowsley: joint appointment

Interview with Anita Marsland, Chief Executive of the PCT and Executive Director of Health and Social Care at Knowsley Council

It was the frontline staff in Knowsley that first cut across the professional and political barriers in health and local government to inspire the borough's now strong tradition of partnerships.

“The frontline staff knew that the only way to make a difference was to work together. There was no formal framework for that but we have a track record of people being pragmatic and getting together to fuel projects.”

Will and mandate for improvement

Encouraged by the borough's frontline workers, she says its leaders had a desire to do things differently. In 2000 this was coupled with a strong political mandate to improve the wellbeing of Knowsley's residents. Leaders and officers "were willing to do whatever it takes" to make the partnership work, which included taking personal and professional risks.

Marsland says there has been no barriers to the partnership in terms of will. The council has been very serious about its commitment to health and social care, both in its funding and policy, with elected members wanting to be champions of health as far as possible. This leadership, vision and the consistency of people have been key to the strength of the partnership. She says:

“Health and wellbeing are everyone's business and we acknowledged that our roles are wider.”

Marsland adds that all partners, including the voluntary and community sector, have been “stitched in at an early stage”.

“For them it has been a joy to be dealing with just one organisation, not several fighting with each other.”

She adds that seven years on the mantra of the PCT and council remains:

“Single accountability to service users and patients with dual governance arrangements”.

Joint appointments

The council and PCT made a number of joint appointments at assistant director level from 2001 onwards, including Marsland's the following year. These arrangements were formalised in a governance structure in 2004, as she concedes that the partnership couldn't simply rely on personalities. She says that getting governance right was time consuming and that structural issues can get in the way of partnership working.

“This is where colleagues in some areas have been challenged. You can do it without getting into complex structural arrangements.”

The joint appointments have eased the path for the partnership significantly.

“We can get on and do things, such as budgets, and we don't have to go through the bureaucracy, we can do business much more efficiently.”

She says Knowsley's way of working has helped attract a lot of people who want to work creatively, but the existing HR framework potentially hinders joint working.

“The contractual arrangements and pensions are too complex. You can move from local government to NHS and keep pensions intact but you can't move the other way. It's frustrating that something as fundamental as employment hasn't caught up yet.”

The partnership is starting to see improvements in the life expectancy of men, cancer targets, smoking cessation and teenage pregnancies. But she says every day still brings challenges.

“We are all on a very steep learning curve and sometimes I am still surprised at the things that emerge.”